CPPM CH 11(FRAUD & ABUSE &
CORPORATE COMPLIANCE) EXAM
QUESTIONS AND ANSWERS
What is the typical length of a corporate integrity agreement (CIA)?
Indefinitely
Seven years
Five years
Until the OIG determines that there are no longer fraudulent actions taking place -
ANSWER-Five years
Federal and state governments have created several statutes governing the business
practices of healthcare organizations. Which is NOT considered a criminal statute?
a. Mail and wire fraud
b. EMTALA
c. Stark Law
d. False Claims Act - ANSWER-a. Mail and wire fraud
According to the OIG, a compliance plan should include:
I. Mandatory external chart reviews
II. Certification of coding and billing staff
III. Internal auditing
IV. Training and education
V. Designate a compliance officer
VI. Internal monitoring - ANSWER-III. Internal auditing
IV. Training and education
V. Designate a compliance officer
VI. Internal monitoring
A 25-year-old female transient arrives at the ER complaining of an earache. The intake
nurse determines the earache is not an emergent condition and tells her to go to the
urgent care clinic. What law has been violated?
a. OSHA
b. EMTALA
c. Qui Tam
d. Stark - ANSWER-b. EMTALA
What is NOT a step involved in a risk investigation?
, a. Risk exposure
b. Evaluate capital losses
c. Evaluating loss control techniques
d. Monitor, improve, refine techniques - ANSWER-b. Evaluate capital losses
The nurse in your office trips over a power cord that is blocking an emergency exit and
suffers a bruised knee. She continues to work through the day and insists she is fine.
Are you required to report the injury to OSHA?
a. Yes; all work-related injuries must be reported to OSHA
b. Yes; failure to report the work-related injury will lead to heavy fines
c. No; it is the employee's determination whether to report an injury to OSHA
d. No; this type of injury is not reported to OSHA - ANSWER-d. No; this type of injury is
not reported to OSHA
A billing clerk in an ASC observes claims being altered to increase the revenue of the
ASC. She documents her observations and discusses them with the compliance officer.
After six-months no action has been taken and the clerk seeks legal counsel and a
claim is filed using what statute?
a. Anti-kickback
b. Qui Tam
c. EMTALA
d. CLIA - ANSWER-b. Qui Tam
When the OIG negotiates compliance obligations with healthcare providers and other
entities as part of the settlement of federal healthcare program investigations arising
under a variety of civil false claims statutes, it is called:
a. OSHA
b. EMTALA
c. CIA
d. EHR - ANSWER-c. CIA
What is the best practice to follow to avoid fraud, waste, and abuse?
a. Develop an audit plan to audit all physicians in the clinic every quarter.
b. Understand the key regulatory laws and implement auditing and monitoring
procedures to ensure compliance.
c. Develop a scheduling system and follow-up plan to avoid missed appointments.
d. Develop a program to identify data entry errors. - ANSWER-b. Understand the key
regulatory laws and implement auditing and monitoring procedures to ensure
compliance.
Which of the following is a violation of the Stark Law?
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